Great read, Jack, thanks for sharing your thoughts! And I’m willing to admit I quickly had to look up what “curmudgeonly” means; great word to add to my vocabulary :)
I found the point on RCTs particularly interesting. How do you think donors should approach the “evidence gap” for interventions that have promising real-world evidence, but where generating the next level of evidence (e.g. through a multi-site RCT) might itself cost several million dollars? At what point should funding that evidence generation become part of the philanthropic bet, rather than stronger evidence being a prerequisite for making the bet?
I feel like there’s a potential catch-22 here: donors may wait for gold-standard evidence before funding at scale, while organisations may not be able to generate that evidence without donors willing to take an earlier-stage risk. What does good grantmaking look like in that gap?
Nice to know the word of day calendar is paying off.
I think donors should use reasonable indicators to judge evidence if an RCT isn’t available, while also being clear with themselves that this makes the grant higher risk. This is relatively easy in global health, where most places are doing decent monitoring, evaluation and learning, and running pre/post studies or difference-in-difference studies of their work. It’s harder in other cause areas, as I just posted about.
If donors have the money, I would love to see more funding specifically for RCTs. I think a funder or group of funders dedicated to this could do an enormous amount of good. You do need a significant amount of capital, though—it’s not uncommon for health RCTs to run to several million dollars per study.
Of course, my mid-stage global health fund aims to do good grantmaking in this gap, but we would need more capital to be the main funder of RCTs.
Great read, Jack, thanks for sharing your thoughts! And I’m willing to admit I quickly had to look up what “curmudgeonly” means; great word to add to my vocabulary :)
I found the point on RCTs particularly interesting. How do you think donors should approach the “evidence gap” for interventions that have promising real-world evidence, but where generating the next level of evidence (e.g. through a multi-site RCT) might itself cost several million dollars? At what point should funding that evidence generation become part of the philanthropic bet, rather than stronger evidence being a prerequisite for making the bet?
I feel like there’s a potential catch-22 here: donors may wait for gold-standard evidence before funding at scale, while organisations may not be able to generate that evidence without donors willing to take an earlier-stage risk. What does good grantmaking look like in that gap?
Nice to know the word of day calendar is paying off.
I think donors should use reasonable indicators to judge evidence if an RCT isn’t available, while also being clear with themselves that this makes the grant higher risk. This is relatively easy in global health, where most places are doing decent monitoring, evaluation and learning, and running pre/post studies or difference-in-difference studies of their work. It’s harder in other cause areas, as I just posted about.
If donors have the money, I would love to see more funding specifically for RCTs. I think a funder or group of funders dedicated to this could do an enormous amount of good. You do need a significant amount of capital, though—it’s not uncommon for health RCTs to run to several million dollars per study.
Of course, my mid-stage global health fund aims to do good grantmaking in this gap, but we would need more capital to be the main funder of RCTs.